When smokers are hospitalized they quit smoking, either voluntarily or involuntarily. Most of them, however, go back to smoking soon after discharge. Research has shown that extended follow-up counseling post-discharge can help prevent relapse. However, it is difficult for hospitals to conduct extended follow up for patients after discharge. The proposed study aims to establish a practical model in which hospitals will work with a state quitline in the following manner: Hospital staff will conduct bedside counseling and then refer patients to the quitline. Quitline counselors will proactively call patients post-discharge and provide counseling up to 2 months. With the proposed project we intend to establish a practical model that lends itself to broader dissemination, while testing the effectiveness ofthe interventions with the rigor of a randomized design. We plan to demonstrate in a randomized trial the effects of two interventions, dispensing nicotine patches at discharge and providing proactive telephone counseling soon after discharge, on the long term quit rates of hospitalized smokers in a 2 x 2 factorial design. All eligible patients receive brief counseling from hospital staff. This is usual care. Study participants are randomly assigned into one ofthe four conditions: usual care, nicotine patch post discharge, telephone counseling post discharge, or both patch and counseling post discharge. It is hypothesized that the patch and counseling each has an independent effect and their combined effect is greater than that for either single intervention. We also intend to compare the cost-effectiveness ofthe interventions: patch alone, counseling alone, and combined interventions, against the usual care condition. Further, the proposed study will allow us to examine if a patient's medical diagnosis is a moderating factor for intervention effects such that patients with certain diagnoses benefit more from the interventions than patients with other diagnoses. (End of Abstract)